Senate Bill 2155 seeks to amend the Tennessee Code Annotated by establishing a new part within Title 56, Chapter 7, which introduces definitions for key terms related to health insurance, such as "artificial intelligence," "downcoding," and "health benefit plan." The bill creates the Tennessee Commission of Insurance Review, composed of seven members, including healthcare professionals and legislators, tasked with reviewing complaints and enforcing the new regulations. This commission will have the authority to adopt rules, issue subpoenas, and conduct informal hearings regarding health insurance practices. Additionally, the bill prohibits health insurance entities from using downcoding to hinder healthcare providers from collecting fees and requires a minimum of 60 days' notice for material changes to health benefit plans, with certain exceptions.

The legislation also addresses the protection of enrollee medical information and the use of artificial intelligence in claim reviews, mandating that any AI-driven reviews be conducted under the oversight of a qualified human healthcare provider. It restricts the removal of enrollees from group plans and prohibits lasering in stop-loss underwriting. Furthermore, the bill ensures that individuals with ownership in both healthcare providers and health insurance entities cannot compel covered individuals to use specific providers. The act includes amendments to existing laws, including the deletion of certain subdivisions, and introduces new reimbursement requirements based on provider licensure classifications. The provisions of the bill are set to take effect on July 1, 2026, applying to conduct occurring on or after that date.

Statutes affected:
Introduced: 4-29-249(a), 4-29-249, 56-7-1013(c), 56-7-1013, 56-7-3302